Detroit Health Department - Third Party Medical Billing & Coding Services

The City of Detroit Office of Contracting and Procurement, on behalf of the Detroit Health Department, seeks qualified firms to provide Third Party Medical Billing & Coding Services through a Request for Quotation (RFQ 543509) for an initial two-year contract term with one optional one-year renewal period. The procurement encompasses comprehensive claims processing, billing, revenue cycle management, electronic and paper claim submission, denial management, accounts receivable management, detailed reporting, and full practice management support for the Department's clinical operations, including Family Planning, Immunizations, Lead Testing, and other public health programs. Minimum qualifications require at least one nationally recognized medical coding certification holder (CPC, CCS, RHIT, or equivalent), one governmental or public health reference within five years, signed attestations for Medicaid and Medicare processing experience and HIPAA compliance, and submission of a redacted sample monthly performance report. Service performance requirements include processing claims within 72 hours of receipt, completing chart reviews within 24 hours, coding claims within 24 hours of service date, and appealing denials within 120 days post-adjudication. Required insurance coverage includes Workers' Compensation, Commercial General Liability of $1,000,000 per occurrence with $2,000,000 aggregate, and Errors and Omission Cyber Liability of $1,000,000 per claim with $5,000,000 aggregate. The contractor must integrate with the Detroit Health Department's Patagonia EHR system, maintain HIPAA compliance, provide weekly practice management reports, and enable data access via APIs in machine-readable formats. A pre-bid conference is scheduled for March 10, 2026 at 3:00 p.m. EDT via Microsoft Teams; questions must be submitted by March 11, 2026 at 3:00 p.m. EDT through the Bonfire Supplier Portal with answers distributed by March 12, 2026; and quotes are due March 20, 2026 at 3:00 p.m. EDT through Bonfire. Award will be made on a price-only basis to the lowest responsive and responsible vendor meeting minimum requirements.

Detroit-based businesses are eligible to receive equalization credit up to 12 percent above the lowest responsible bid or $100,000, whichever is less, upon submission of a CRIO-issued Detroit Based Business certificate; additional equalization allowances ranging from 1 percent to 5 percent are available for businesses certified as Detroit Resident, Detroit Headquartered, Detroit-Based Small Business, Detroit-Based Micro Business, Construction Workforce Investment, Construction Workforce Development, Joint Venture, or Mentor Venture entities. Per Section 17-5-12(d) of the Detroit City Municipal Code, the Purchasing Director may limit bidding to Detroit-based businesses if at least three certified or eligible firms exist. All respondents must submit comprehensive supporting documentation including notarized City of Detroit Consolidated Affidavits, certificates of authority, non-collusion affidavits, three years of financial statements, proof of City of Detroit Treasury Clearance (requiring a minimum of 10 days to process), and System of Awards Management (SAM) registration documentation for federally funded projects (requiring 10-15 days to complete). The solicitation documents do not specify an identified incumbent vendor or budget range; however, the cost structure includes five line items covering firm fixed price for medical billing and coding services, percentage of collections, process analysis and training (capped at 10 hours monthly without city approval), credentialing services, and postage reimbursement on monthly or hourly bases. The contractor must obtain proof of ISO 27001 certification or annual SOC 2 Type 2 Reports and maintain strict data protection protocols with immediate breach notification within ten days of discovery. Interested vendors may contact the Civil Rights, Inclusion & Opportunity Department at 313.224.4950 or CivilrightsCert@detroitmi.gov for certification information.